title: Economic instruments for population diet and physical activity behaviour change: a systematic scoping review.
abstract: BACKGROUND
  Unhealthy diet and low levels of physical activity are common behavioural factors in the aetiology of many non-communicable diseases. Recent years have witnessed an upsurge of policy and research interest in the use of taxes and other economic instruments to improve population health.
  
  
  OBJECTIVE
  To assemble, configure and analyse empirical research studies available to inform the public health case for using economic instruments to promote dietary and physical activity behaviour change.
  
  
  METHODS
  We conducted a systematic scoping review of evidence for the effects of specific interventions to change, or general exposure to variations in, prices or income on dietary and physical activity behaviours and corollary outcomes. Systematic electronic searches and parallel snowball searches retrieved >1 million study records. Text mining technologies were used to prioritise title-abstract records for screening. Eligible studies were selected, classified and analysed in terms of key characteristics and principal findings, using a narrative, configuring synthesis focused on implications for policy and further research.
  
  
  RESULTS
  We identified 880 eligible studies, including 192 intervention studies and 768 studies that incorporated evidence for prices or income as correlates or determinants of target outcomes. Current evidence for the effects of economic instruments and exposures on diet and physical activity is limited in quality and equivocal in terms of its policy implications. Direct evidence for the effects of economic instruments is heavily skewed towards impacts on diet, with a relative lack of evidence for impacts on physical activity.
  
  
  CONCLUSIONS
  The evidence-based case for using economic instruments to promote dietary and physical activity behaviour change may be less compelling than some proponents have claimed. Future research should include measurement of people's actual behavioural responses using study designs capable of generating reliable causal inferences regarding intervention effects. Policy implementation needs to be carefully aligned with evaluation planning and design.
authors.affiliation: Behaviour and Health Research Unit, University of Cambridge, Cambridge, United Kingdom.
authors.forename: Ian
authors.initials: I
authors.lastname: Shemilt
authors.forename: Gareth J
authors.initials: GJ
authors.lastname: Hollands
authors.forename: Theresa M
authors.initials: TM
authors.lastname: Marteau
authors.forename: Ryota
authors.initials: R
authors.lastname: Nakamura
authors.forename: Susan A
authors.initials: SA
authors.lastname: Jebb
authors.forename: Michael P
authors.initials: MP
authors.lastname: Kelly
authors.forename: Marc
authors.initials: M
authors.lastname: Suhrcke
authors.forename: David
authors.initials: D
authors.lastname: Ogilvie
mesh_terms: D001519:Behavior; D003132:Commerce; D004032:Diet / Q000191:economics*; D006801:Humans; D007182:Income; D009043:Motor Activity